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Photodynamic diagnosis of pleural malignant lesions with a combination of 5-aminolevulinic acid and intrinsic fluorescence observation systems.

Kitada M, Ohsaki Y, Matsuda Y, Hayashi S, Ishibashi K - BMC Cancer (2015)

Bottom Line: Malignant lesions on the pleural surface emitted pink autofluorescence in contrast to the green autofluorescence of the surrounding normal tissues.The latter 5 patients had been diagnosed with PL1 preoperatively or intraoperatively.This system achieved accurate localization of malignant lesions, suggesting that it may also be applicable to photodynamic therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan. k1111@asahikawa-med.ac.jp.

ABSTRACT

Background: We have developed a new diagnostic method using the photosensitizer 5-aminolevulinic acid (5ALA) for diagnosing intrathoracic malignant lesions. When ingested exogenously, 5ALA is metabolized to a heme precursor, protoporphyrin IX, which stays in malignant cells and emits red to pink luminescence of about 630 nm.

Methods: We enrolled 40 patients who underwent respiratory surgery and consented to participate in this study. Twenty-eight patients had primary lung cancer, 8 metastatic lung tumors, 2 malignant pleural tumors, and 2 benign tumors. Localization of malignant lesions was attempted by observing such lesions with an autofluorescence imaging system and by comparing the color tone of the autofluorescence between malignant lesions and normal tissues after oral administration of 5ALA. Malignant lesions on the pleural surface emitted pink autofluorescence in contrast to the green autofluorescence of the surrounding normal tissues.

Results: When 28 patients with primary lung cancer were examined according to the degree of pleural infiltration (pl), red fluorescence was confirmed in 10 of 10 patients (100%) with p11-p13 and 5 of 18 patients (27.7%) with p10. The latter 5 patients had been diagnosed with PL1 preoperatively or intraoperatively.

Conclusion: This system achieved accurate localization of malignant lesions, suggesting that it may also be applicable to photodynamic therapy.

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Related in: MedlinePlus

The metabolic pathway of 5ALA. Exogenous 5ALA is ingested and promptly metabolized to heme in normal cells. In contrast, the fluorescent substance protoporphyrin IX accumulates selectively in cancer cells, emitting red to pink fluorescence of about 630 nm, because cancer cells have high porphobilinogen deaminase activity and low ferrochelatase activity.
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Fig3: The metabolic pathway of 5ALA. Exogenous 5ALA is ingested and promptly metabolized to heme in normal cells. In contrast, the fluorescent substance protoporphyrin IX accumulates selectively in cancer cells, emitting red to pink fluorescence of about 630 nm, because cancer cells have high porphobilinogen deaminase activity and low ferrochelatase activity.

Mentions: 5ALA is the starting material in the 5-porphiline synthetic pathway, and is a natural amino acid in the human body. It is an endogenous amino acid synthesized from glycine and succinyl CoA in mitochondria, and is also a precursor of hemoglobin. When exogenous 5ALA is ingested, it is promptly metabolized to heme in normal cells. In contrast, in cancer cells, where the activity of porphobilinogen deaminase is high and the activity of ferrochelatase is low, the fluorescent substance protoporphyrin IX accumulates selectively. Consequently, red to pink fluorescence of about 630 nm is emitted (Figure 3). ALA does not stagnate at the infection part of the lung.Figure 3


Photodynamic diagnosis of pleural malignant lesions with a combination of 5-aminolevulinic acid and intrinsic fluorescence observation systems.

Kitada M, Ohsaki Y, Matsuda Y, Hayashi S, Ishibashi K - BMC Cancer (2015)

The metabolic pathway of 5ALA. Exogenous 5ALA is ingested and promptly metabolized to heme in normal cells. In contrast, the fluorescent substance protoporphyrin IX accumulates selectively in cancer cells, emitting red to pink fluorescence of about 630 nm, because cancer cells have high porphobilinogen deaminase activity and low ferrochelatase activity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4374504&req=5

Fig3: The metabolic pathway of 5ALA. Exogenous 5ALA is ingested and promptly metabolized to heme in normal cells. In contrast, the fluorescent substance protoporphyrin IX accumulates selectively in cancer cells, emitting red to pink fluorescence of about 630 nm, because cancer cells have high porphobilinogen deaminase activity and low ferrochelatase activity.
Mentions: 5ALA is the starting material in the 5-porphiline synthetic pathway, and is a natural amino acid in the human body. It is an endogenous amino acid synthesized from glycine and succinyl CoA in mitochondria, and is also a precursor of hemoglobin. When exogenous 5ALA is ingested, it is promptly metabolized to heme in normal cells. In contrast, in cancer cells, where the activity of porphobilinogen deaminase is high and the activity of ferrochelatase is low, the fluorescent substance protoporphyrin IX accumulates selectively. Consequently, red to pink fluorescence of about 630 nm is emitted (Figure 3). ALA does not stagnate at the infection part of the lung.Figure 3

Bottom Line: Malignant lesions on the pleural surface emitted pink autofluorescence in contrast to the green autofluorescence of the surrounding normal tissues.The latter 5 patients had been diagnosed with PL1 preoperatively or intraoperatively.This system achieved accurate localization of malignant lesions, suggesting that it may also be applicable to photodynamic therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan. k1111@asahikawa-med.ac.jp.

ABSTRACT

Background: We have developed a new diagnostic method using the photosensitizer 5-aminolevulinic acid (5ALA) for diagnosing intrathoracic malignant lesions. When ingested exogenously, 5ALA is metabolized to a heme precursor, protoporphyrin IX, which stays in malignant cells and emits red to pink luminescence of about 630 nm.

Methods: We enrolled 40 patients who underwent respiratory surgery and consented to participate in this study. Twenty-eight patients had primary lung cancer, 8 metastatic lung tumors, 2 malignant pleural tumors, and 2 benign tumors. Localization of malignant lesions was attempted by observing such lesions with an autofluorescence imaging system and by comparing the color tone of the autofluorescence between malignant lesions and normal tissues after oral administration of 5ALA. Malignant lesions on the pleural surface emitted pink autofluorescence in contrast to the green autofluorescence of the surrounding normal tissues.

Results: When 28 patients with primary lung cancer were examined according to the degree of pleural infiltration (pl), red fluorescence was confirmed in 10 of 10 patients (100%) with p11-p13 and 5 of 18 patients (27.7%) with p10. The latter 5 patients had been diagnosed with PL1 preoperatively or intraoperatively.

Conclusion: This system achieved accurate localization of malignant lesions, suggesting that it may also be applicable to photodynamic therapy.

Show MeSH
Related in: MedlinePlus